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Graft Versus Host Disease

Definition

Graft versus host disease is a serious condition that can occur after a bone marrow transplant or blood transfusion.

What is going on in the body?

Bone marrow transplant is a procedure that is used to treat life-threatening conditions, such as cancer. As part of a bone marrow transplant, a person's blood cells are destroyed with radiation therapy or chemotherapy medications. The person then receives blood cells from a donor. Some of the donated blood cells are white blood cells. These are the infection fighting cells of the body. These donor white blood cells may attack the person's body and cause disease. This condition can also occur after a blood transfusion, usually in people with weakened immune systems.

Risks

What are the causes and risks of the disease?

Graft versus host disease would occur in almost every bone marrow transplant if special medications to suppress the immune system were not given to the person receiving the transplant. This disease affects elderly people more often than younger individuals. For this reason, elderly patients frequently are not offered this therapy. People who have not undergone bone marrow transplant or blood transfusion are not at risk for this condition.

Prevention

What can be done to prevent the disease?

People who have a bone marrow transplant need to take powerful medications. These medications help suppress the donated white blood cells so they don't attack the person's body. Special blood filtering procedures or radiation of blood products may be performed to lessen the risk after a transfusion.

Diagnosed

How is the disease diagnosed?

The healthcare professional can usually make a diagnosis based on the person's symptoms and the findings of a physical exam. Blood tests may be needed to confirm the diagnosis. Rarely, a biopsy of one of the affected areas may be required.

Long Term Effects

What are the long-term effects of the disease?

Graft versus host disease puts the affected person at a greater risk for infection. These infections are often severe since the person's immune system is already weakened by medications. Death may occur from graft versus host disease.

Other Risks

What are the risks to others?

Graft versus host disease is not contagious so there is no risk to others.

Treatments

What are the treatments for the disease?

The condition is treated by giving an affected person higher doses of the medications that suppress the donated white blood cells. Sometimes, additional medications to suppress the immune system are required.

Side Effects

What are the side effects of the treatments?

The medications used to prevent and treat graft versus host disease are powerful medications with many side effects. These may include:
  • stomach upset
  • kidney damage
  • liver damage
  • low blood cell counts
  • an increased risk of infection

After Treatment

What happens after treatment for the disease?

If a person recovers from graft versus host disease after a bone marrow transplant, he or she often will still need to take medications and have frequent check ups.

Monitor

How is the disease monitored?

An individual will need to keep track of any symptoms that develop. He or she will also need regular physical exams and blood tests.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

Cancer - Principles and Practice of Oncology, 1997, DeVita et al.

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